Effleurage
Any stroke that glides over the skin without attempting to move the muscle beneath. Apply firm even pressure. Effleurage strokes are usually directed toward the heart.
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Is used more than any other stroke Usually begins and ends each treatment Used as a bridge between many strokes Accustoms the patient to the touch of the operator Allows the operator to search for areas of spasms and soreness Allows the operator to become familiar with the condition of the patient's muscles Increases circulation to the skin and more superficial muscles Bilateral Effleurage

Start at the lower back with one hand on each side of the spine. Go towards the upper back, all the way to the shoulders. While returning to the lower back go along the sides of the back. To give a deeper massage lean your body weight into the massage.

Alternating Hand Effleurage (Shingles) Start with one of your hands to the side of the spine at the lower back. Move that hand forward 6-8 inches and then follow it with the other hand. Remove the hand that is in the front and place it behind the other hand. Do this several times to slowly work your way up the back (to get to the top of the back should take atleast 12-14 cycles).

Raking Start with your fingers besides the spine at the bottom of the rib cage. Have one finger inbetween each rib with your lower finger between your last rib. With your fingers inbetween the ribs follow the ribs all the way down to the side of the back and then return back to the spine. Repeat this all the way to the top of the rib cage. Move up one rib at a time

Friction
Friction is a stroke that pokes through the skin and massages the underlying muscles. While doing friction "put on the skin like a glove" to reach through it and massage the muscles. Ask the patient frequently if you are deep enough or if you are too deep. Always do friction on the opposite side of the spine from where you are standing. Strokes are usually done in the direction of the muscle fibers
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Works the deeper tissues Breaks up adhesions Breaks up "knots" Increase circulation to the muscles Thumb Friction

Small circles made with the thumb

Fingertip Friction Small circles made with the fingertips of both hands joined by the index fingers

Cresting Friction Small circles made with the part of your fingers inbetween your knuckles

Palm Friction Small circles made with the palm Alternating Thumb Friction With both thumbs side by side bring one thumb forward while bringing the other back. Then bring the one back while bringing the other forward. When going shallow go faster and slower when going deeper

Cross Fiber Friction (Peeling) Use the part of your palm near your thumb as a "potatoe peeler".
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Try to "peel" the skin back and forth going across the fibers of the muscle instead of with the fiber of the muscles.

WEB effleurage on retracted scapula place patients left hand on their lower back. Place your left hand under their shoulder and elbow under their elbow. Lift your left hand up to retract their scapula. Massage under scapula.

15 Laws of a Good Massage
1. Wash hands before every massage. 2. Make sure fingernails are trimmed and filed. 3. Do not use cold hands (if necessary warm hands with warm water). 4. Take off watches and all other items that might scratch the patient. 5. Use a clean room to give the massage in. 6. Do not over or under lubricate the patient. 7. Put a pillow under the patients ankles. 8. Never take your hands off the patient after you start the massage. 9. Always massage a muscle that is relaxed. 10. Never cross the spine with pressure when you are giving the massage. 11. Massage on the opposite side that you're working on when your doing friction. 12. Always work toward the head. 13. Never massage in a untidy or cluttered room. 14. Use good posture while giving the massage. 15. Always remember to get feedback from the patient.

Misc. Things to Remember
Care of the Hands The hands are the most valuable tool a massage therapist has. They should be taken care and kept in a presentable manner. The fingernails should be kept short, filled and clean. The hands should be washed before and after each massage so that you don't transfer the diseases from one patient to another. The hands should be warm when you give the massage. Be careful not to do any activities that might give you a blister before you give a massage. Would you want someone to massage you with dirty hands? Would you want to receive a massage from someone that is scratching you with their long nails? Posture Remember to maintain good posture while giving a massage. When your giving 3 or 4 massages a day having good posture makes a difference in the way you'll feel at the end of the day. Stand erect and have your feet spread a part shoulder length. Instead of stooping to give strokes that require you to be closer to the patient (like tapotement & petrissage) spread your legs apart more. Give a massage on a table that is the proper height for you (A good test is to stand erect, arms at your sides, and if the table is about where your palms begin then it is fine.) By following the rules of posture you will keep yourself from needing a massage at the end of the day. Positioning of the Patient
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The patient should be in a position that will allow him to be relaxed while he is receiving the massage. Make sure the patient is comfortable and not lying bent to one side. Put a pillow under the patient's ankles to ensure that his feet are comfortable. The muscle that you are massaging should be completely relaxed. Ask the patient before beginning the massage if he is comfortable and if there is anything that he needs. People are very timid when it comes to massage therapists and they rarely complain. They might be in a very uncomfortable position yet not say anything because they think that you might have put them in that position for a reason. Always remember to keep good communication with the patient.

Definitions of Direction Terms
Superior means toward the head, and inferior means toward the feet. Example the mouth is inferior to the nose, but the mouth is superior to the chin. Anterior means from front or in front of; and posterior means back or in back of. Example the knees are on the anterior surface of the body but the back is on the posterior. Medial means toward the middle of the body, and lateral means toward the side or outer part of the body. Example the nose lies medial to the eyes.

Proximal means closer to the trunk or point of origin of a body part, and distal means farther from the trunk or body part. Example the hand lies at the distal end of the elbow, but is on the proximal end of the fingers. Superficial means closer to the surface and deep means more in depth. Example if your patient is feeling pain when you give him the massage, give him a more superficial massage. Supine means lying on your back and prone means to lie face down. The plane that cuts across your stomach. It would but you from one hip to the other The plane that cuts right down the middle of your body. It would cut you from your nose to your belly button. A plane that cuts you down your side. It would cut you from your ear though your hip to your feet.

"The body is in an erect or standing posture with the arms at the sides and the palms forward. The head and feet also point forward." Structure & Function of the Body. Thibodeau - Ninth Anatomical Position edition. P. 9. This position is the position that you use to judge all the other terms by. Example, no matter what position the arms are in the radial artery lies on the anterior side.